A Georgia school bus driver was arrested and charged with DUI for weaving over the road while reportedly under the influence of Xanax and other prescription medications. Another driver, this one in Michigan, may have blacked out right before her bus struck a parked car. She had in her purse prescription medications; some were prescribed to her and others were not.

In separate incidents, a school bus driver in Pennsylvania and one in Utah admitted to being impaired by prescription medications while driving students and teachers on field trips and were reported to have been drifting into other lanes and getting dangerously close to other vehicles.

Although these stories from the past year or so comprise an extremely small portion of school bus drivers and are not representative of typical bus driver behavior by any means, they are frightening, especially given that a rise in prescription and illicit drug abuse in the U.S. has been widely reported in the media.

“We have tremendously good firewalls in our system. Our record speaks well to that, absent some of those anecdotal stories that we all hear.” Mike Martin, executive director, National Association for Pupil Transportation

Meanwhile, there appears to also be an uptick in the use of illicit drugs in the U.S. after years of declines, according to forensic drug testing laboratory service provider Quest Diagnostics’ most recent annual drug testing index. The number of workers testing positive for drugs such as marijuana, heroin, or methamphetamine has reached the highest level in a decade, even in the safety-sensitive workforce, which includes school bus drivers. Among safety-sensitive workers, positive tests rose to 1.8% from 1.7% in 2015, according to a news release from Quest Diagnostics.

Although Mike Martin, executive director of the National Association for Pupil Transportation (NAPT), says he has not seen any evidence of a spike in prescription misuse or drug abuse in school transportation beyond the anecdotal, he thinks a heightened awareness of abuse of any drugs, whether prescription or illicit, is necessary, just as it is in all safety-sensitive professions.

“We have tremendously good firewalls in our system. Our record speaks well to that, absent some of those anecdotal stories that we all hear.”

Additionally, the Federal Motor Carrier Safety Administration (FMCSA) has reduced the minimum annual percentage rate for random controlled substances testing for CDL holders from 50% of the average number of driver positions to 25% as of 2016. The change was based on the controlled substances random test data for 2011, 2012, and 2013, when the positive rate for controlled substances random testing fell below the 1.0% threshold.

Still, Martin adds, the school transportation industry has to review the training it offers not only to drivers and potential drivers, but also to directors, supervisors, and other employees who hire staff members.

“There are any number of federal and state requirements, some of which have changed over the last 12 to 18 months, and it’s incumbent on all of us to make sure that people in positions of hiring and supervising have the most up to date information and training available,” he says.

As with Martin, several other pupil transportation leaders have told School Bus Fleet that they have not seen corresponding spikes in drug test positives among their workforce, but that potential drug misuse remains a concern, and preventive measures are being taken to ensure safety and the health of school bus drivers.

The Quest Diagnostics index found a rising positivity rate for post-accident urine drug testing in both the general U.S. and federally mandated, safety-sensitive workforces. In addition, post-accident positivity for the safety-sensitive workforce has risen 22% during a five-year time period, according to a news release from Quest Diagnostics.

It doesn’t take much to spike drug test positives because they are so low, but the U.S. is facing the reversal of a trend of declines, says Dr. Donna Smith, a regulatory compliance officer at Workforce QA, a workplace safety training and testing administrator.

“We had felt that our prevention and control programs were working, not only in transportation, but overall, because of continually driving the positivity rate down,” she says. “Looking at the past four years, we see that is not the case.”

Although Smith says it isn’t certain whether the school bus industry mirrors results in the general transportation industry or the U.S. workforce, there’s no reason to think that it would be different.

There appears to be an uptick in the use of illicit drugs in the U.S. after years of declines, according to forensic drug testing laboratory service provider Quest Diagnostics’ most recent annual drug testing index.

Prescription medication misuseA common situation that leads to prescription medication misuse is when someone suffers pain, say, in the shoulder or lower back, and is prescribed an opiate painkiller. It helps for a while, but the pain returns. They go back to the doctor, complain about the pain, get prescribed a higher dosage, develop a tolerance, and take more pills than prescribed to treat the pain and become addicted, says Jerry Gjesvold, manager of employer services at Serenity Lane, an inpatient residential hospital in the Eugene, Oregon, area.

Prescription medications aren’t the only cause for concern, though. Over-the-counter medications such as antihistamines, which can make a person drowsy, or Tylenol with codeine (sold over the counter in Canada) are also potentially dangerous while driving, says Allan Jones, former director of student transportation at the Washington Office of Superintendent of Public Instruction (Jones retired in September).

To ensure drivers are aware of this, Washington school districts recently held an in-service training on prescription drugs and explained that even legal drugs, such as cold medicines, can produce a positive test result, he adds.

Most districts in Washington and Oregon, as well as other states, require drivers to report to them any prescription drugs that they are taking that could impact their ability to drive, such as a painkiller or other medication with side effects that create impairment, and present a doctor’s note explaining whether or not they can drive and under what conditions.

Drug abuseThe most concerning factors for the safety-sensitive workforce are skyrocketing heroin use, and an increase in amphetamine and marijuana consumption.

Smith says the increase in heroin use is a direct result of the tail end of the OxyContin, oxycodone, and narcotics painkiller epidemic in the U.S. Those opiates were easily obtainable, especially from pill mills, but then several states and other jurisdictions cracked down on them. Then, people who were addicted to them did not have as much access, but on the street they could buy heroin in pill or powder form even cheaper.

“We can’t say that the heroin rise wouldn’t be affecting school bus drivers or other transportation workers,” Smith says. “I don’t think people are setting out to [use heroin]. It’s a drug of opportunity, because of what was going on with them medically before.”

There is a corresponding age-related increase among school bus drivers and transportation workers in general in the number of drivers using amphetamines.

“Adult Attention Deficit Disorder and [diagnoses] associated with being unable to focus are the diagnoses of the year for people who are over 50,” Smith says. “We are seeing a lot more CDL holders who are being prescribed Adderall or an amphetamine such as Vyvanse, [often] prescribed for weight loss.”

“You can’t recreate with [marijuana] if you are going to drive a school bus. ... There is so much confusion about where school bus drivers stand.” Chris Ellison, transportation manager, Eugene (Ore.) School District 4J

Impacts of legalizing marijuanaThe spike in illicit drug use, which started in 2012, overlaps with legislation that passed in Colorado and Washington allowing recreational use of marijuana. More than 20 other states have legalized marijuana in some form since then.Nine states are voting on allowing either medical use (Arkansas, Florida, North Dakota, and Montana) or recreational use (Arizona, California, Massachusetts, Nevada, and Maine) of the drug this November. Because of this, Smith says she believes the U.S. has basically legitimized marijuana over the last three years.

“Public acceptance of marijuana has made a difference in the risks people are willing to take regarding their job, even those in driving positions, who would not have thought about smoking marijuana [on social occasions] five years ago, because they do not see it as dangerous behavior,” she says.

However, although states that have legalized marijuana use in some form have shown higher positivity rates of the drug, those numbers have not increased in Colorado and Washington since 2014, Dr. Barry Sample, director of science and technology for Quest Diagnostics Inc.’s employer solutions business, told The Wall Street Journal.

Chris Ellison, the transportation manager at Eugene School District 4J, had to rescind a job offer to an interviewee because the person tested positive for marijuana. When Ellison told them about the failed drug test, the person’s response was, “Is that going to be a problem?”

“Some people don’t connect the dots that even though marijuana is legal [in Oregon], you can’t recreate with it if you are going to drive a school bus, because you are in a safety-sensitive position,” he adds. “That was disheartening. It was the first time for us, but I know it’s not going to be the last. There is so much confusion about where school bus drivers stand.”

Looking to Colorado, another state in which recreational marijuana is legal, zero tolerance policies vary by district. Denver Public Schools (DPS) has a zero-tolerance policy and has, through random testing, identified only a few employees who have used marijuana, says Nicole Portee, executive director of transportation.

DPS’ policy states that, in compliance with federal regulations, certain district employees are subject to alcohol and drug testing. That includes bus drivers and any transportation department employee holding a safety-sensitive position, including mechanics, supervisors, managers, and directors. Supervisors, directors, and trainers also undergo reasonable suspicion training at least every other year.

“We have reiterated to our employees that even though marijuana is legal in the state of Colorado, it is illegal at DPS,” Portee says. “There is an assumption that just because the state passed it, it’s OK for employees to use. That is not a message you want to send to your community.”

DPS terminal directors also reiterate to employees the safety-sensitive aspect of their work.

“We are trying to be very open about the importance of our policies, the federal and state [laws], and why we put certain measures in place as a result,” Portee explains. “We want to make sure our employees are safe on the road and understand that thousands of families rely on us to safely get students home.”

Washington state districts have had very few positive tests for marijuana since recreational use was legalized, and those are dealt with on a case-by-case basis (only some districts have zero-tolerance policies). The first time a driver tests positive, if they get the required substance abuse professional evaluation, then it’s up to the district whether it wants to continue to employ that driver, as long as the district and driver have a stipulated agreement with the Washington State Office of Superintendent of Public Instruction that the driver will now be drug-free.

The Oregon Pupil Transportation Association focused its 2016 Winter Workshop on educating attendees about the effects of drugs and alcohol after recreational marijuana was legalized in the state. In one workshop exercise, attendees wore goggles that simulate the experience of being under the influence of alcohol or drugs.

Health, driver shortage concernsAlthough school bus drivers tend to be highly conscientious and safety-minded, could health vulnerabilities and working in a largely sedentary job lead to issues of prescription misuse or drug use in some cases?

The average age of school bus drivers today is higher than it was about 20 years ago, and older drivers tend to have more pain medications prescribed to them, Workforce QA’s Smith notes.

It is also possible that drivers might try amphetamines, like Vyvanse or Adderall, to combat fatigue from sleep apnea.

“We can’t say that we don’t have to worry about this touching the school bus driver community because I think it is,” Smith says.

If the increase in sleep study orders and shorter windows for medical certification are any indication, incidents of sleep apnea may be up, transportation directors say.

In California, medical certification examiners listed on the National Registry are noticeably stricter now, sometimes issuing certificates that are valid for as short as three months if they detect health problems such as sleep apnea or high blood pressure, says Dano Rybar, a transportation consultant at the California Department of Education.

Max Christensen, state director of pupil transportation at the Iowa Department of Education, echoes that observation. He says that Iowa has seen an uptick in the shrinking of medical card time frames, especially for sleep apnea and diabetes.

Amid health concerns about school bus drivers, many transportation directors are struggling to recruit and retain them, particularly in states that require drivers to obtain medical certification.

“It’s a related issue,” says Charlie Hood, executive director of the National Association of State Directors of Pupil Transportation Services (NASDPTS). “I am not suggesting that there are a large number of drivers who aren’t physically qualified. I know that’s not the case, but it has become more difficult to recruit and retain drivers for various reasons. Certainly tight physical standards are part of it. They don’t want drivers with unacceptable levels of hypertension and [other factors] that affect their ability to drive safely.”

In Nevada, medical certification is required, primarily at the request of school districts, to drive on a field trip that crosses state lines, says Diana Hollander, program officer at the Nevada Department of Education and NASDPTS president. While she has been a longtime supporter of the requirement, she says that rescinding it may be a way to help alleviate the driver shortage.

“We certainly don’t want drivers on the road if they have potential to have an emergency,” Hollander says. “But from what I have seen, even with medical [certification], you don’t always know. You can have a medically certified, qualified driver who has a heart attack behind the wheel.”

Although many districts across the U.S. have wellness programs with group activities and incentives to stay fit and exercise, Hollander stresses the need for more, particularly for those who struggle with weight, high blood pressure, and diabetes.

“Weight is a significant issue, which leads to questions of ability. There are requirements you have to meet: drag students, walk so far, etc. But can we afford to lose a good driver because of it? The answer is no.”

Preventive measuresConversely, Smith notes that the FMCSA’s recent tightening of the medical exam process for commercial drivers has helped screen them for prescription medication misuse.

A medical examiner who is certified on the National Registry asks school bus drivers who are required by the state to take the U.S. Department of Transportation (DOT) physical what medications they are taking and checks the state registry to see if they have a prescription. Then, they test for substances such as methadone, fentanyl, and oxycodone, which isn’t part of a school district’s pre-employment test, she explains.

Also, the random drug testing program had been decreasing the amount of illicit drug use by school bus drivers and other regulated transportation workers for some time, Smith says. Consequently, she advises not decreasing testing from 50% to 25%, despite the change in federal requirement, because it has been an effective deterrent in the past. About half of Workforce QA’s school district clients are continuing random testing at 50% because of the nationwide drug abuse epidemic, Smith says.

“It is a well-administered program and gives drivers no notice, yet puts them on notice, that there is no period of time when they are safe to use drugs,” Smith says.

Smith also points out that school districts shouldn’t be afraid to require their drivers to notify them when they are prescribed a controlled substance medication, because an exception is made in Health Insurance Portability and Accountability Act (HIPAA) confidentiality rules, the Americans with Disabilities Act (ADA), and medical marijuana statutes for DOT-regulated, safety-sensitive positions.

To prevent a rise in positive marijuana drug tests, Denver Public Schools changed its process for checking in its drivers every morning and afternoon, Portee says. The process now requires them to come into the office and pick up their own keys, which allows staff to do a visual check of the drivers.

Education, awarenessSoon after recreational use of marijuana became legal in the state, on July 1, 2015, the Oregon Pupil Transportation Association (OPTA) planned to focus its 2016 Winter Workshop on educating attendees about the effects of drugs and alcohol.

The workshop made drivers aware of the effects of various prescription drugs, marijuana, alcohol, and insomnia. It also stressed to drivers that the choices they make not only impact them, but their coworkers and others surrounding them, and they need to be aware of their coworkers and report problems, says Sandi Miller, transportation supervisor of special-needs routing for Eugene School District 4J.

“That was the [theme] of the day: It’s not just the driver who is under the influence. If you are a coworker who sees these things, you have a responsibility, because prescription drug abuse is on the rise,” Miller says.

Gjesvold and other staff members from Serenity Lane discussed how prevalent a problem prescription drug misuse has become in the U.S., and how it could impact the workplace. They also shared signs that indicate drug or alcohol abuse, such as the smell of alcohol or marijuana, slurred speech, glassy eyes, and appearing to be disoriented.

Gjesvold says that when he teaches classes on reasonable suspicion drug testing, he has found that for supervisors, the challenge is not just dealing with drug and alcohol abuse itself, but identifying it and potential fallout.

Employers want supervisors to identify employees who are under the influence of drugs and alcohol, but many supervisors are concerned about conflict or that they may be wrong. As a result, they often see indicators and don’t address them.

“Human resources [managers] will say when there is a crisis and they begin the investigative process, they find out stuff that should have been dealt with a long time ago, but wasn’t because of these reasons,” Gjesvold adds.

When training supervisors, he recommends that if they spot an indicator, they do what he calls “sharing the risk.”

“Make sure that somebody above you is aware of what you are aware of, because a supervisor is considered under labor law an agent of the employer.”

OPTA workshop attendees tried on goggles that simulate the experience of being under the influence of alcohol or drugs.

OPTA also showed videos of two versions of one story. In one, bus drivers make the wrong decisions regarding drugs and alcohol — such as going on a drinking binge, and accepting expired prescription painkillers from a coworker — and get into an accident. In the other, Ellison says, coworkers make the right choices, such as noticing the smell of alcohol on a coworker’s breath and reporting it to their supervisor, and in that version, the accident doesn’t happen.

The Houston Independent School District (HISD) transportation department and the Houston Educational Support Personnel Union (HESP) have teamed up to fight heart disease and encourage employees to develop healthy lifestyle habits with their “Love Your Heart” initiative. About 200 employees gathered in July to celebrate the joint effort between the transportation department and HESP to raise awareness of the importance of checking one’s heart health. Transportation department General Manager Nathan Graf played the role of Dr. Healthy Hound, the mascot for the initiative. Love Your Heart, which includes the transportation staff routinely going on walks together, is available to all transportation department employees. The Love Your Heart initiative is just one collaboration between the transportation department and HESP to improve health awareness among district employees. Both groups launched the fitness series “Move It and Lose It” and the Health Conscious Exercise program in 2014. Bus drivers who participated in the Health Conscious Exercise program have shown reduced blood pressure and cholesterol rates, and have passed health physicals in larger numbers than in previous years, according to HESP.